SM A Division of Health Care Service Corporation a Mutual Legal Reserve Company an Independent Licensee of the Blue Cross and Blue Shield Association Copyright 2013 All rights reserved bcbsokcom ID: 258155
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BlueEdge HSA
SM
A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association. Copyright © 2013. All rights reserved.
bcbsok.comSlide2
*
America’s Health Insurance Plans (AHIP), Center for Policy and Research, 2013Source: BlueEdge Value Story, 2012
High Deductible Health Plan
Benefits – What are the benefits?Define the benefitsExamplesDifference between BlueEdge/BlueOptionsPremium Difference Health Savings Account
What is it?
Advantages
EligibilityContribution RulesBenefit Wallet (Bank)Member Experience
BlueEdge HSASM
Discussion Items 2Slide3
3
What are the Benefit Differences
BENEFITBLUEOPTIONSBLUEEDGE PPO Provider Network
BluePreferred (BP) BlueChoice (BC)BlueChoice Office Visit Copayments$30.00 Primary Care $50.00 Specialist No Office Visit CopaymentsDeductible$750.00 Individual BP/BC/$2,250 FamilyEmbedded* $1,500 Deductible / $3,000 FamilyAggregate*Coinsurance80% In Network 80%Out of Pocket
$4,250 Individual/$12,700
Family
Embedded*$4,000 Individual/$8,000 FamilyAggregate*Pharmacy Benefits $4.00 Generic$50.00 Preferred $100.00 Non PreferredSubject to Deductible and Out of Pocket Maximum – Member must meet deductible before insurance paysSavings Account with Investment Options NoYes
Embedded - For services that are subject to the plan deductible, once the Individual Deductible is met, the member does not have to wait for the entire Family Deductible to be satisfied before benefits are payable.Aggregate - For services that are subject to the plan deductible, the entire Family Deductible must be satisfied before benefits are payableSlide4
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Office Visit Claim In Network
OFFICE VISIT Member has an office visit for Bronchitis and seeks services from their PCP Total Charge: $300.00
Allowable Charge: $250.00Deductible: $250.00Member Responsibility: $250.00 BlueEdge Plan - The members responsibility is $250.00 because there is no office visit copayment on the plan. EVERYTHING, except preventative care will apply to the benefit period deductible before health insurance is paid. Total Charge: $300.00Allowable Charge: $250.00Office Visit Copay: $30.00Deductible: $0.00Member Responsibility: $30.00 BlueEdge High Deductible
BlueOptions Slide5
5
Preventative Claim In Network
OFFICE VISIT Member has a routine physicalTotal Charge: $200.00
Allowable Charge: $175.00Member Responsibility: $0.00 Both plans cover preventative care at 100% of allowable charge. ***Preventative care is the ONLY type of services that will be covered at 100% of allowable when deductible and out of pocket have not been satisfied. BlueEdge High Deductible Total Charge: $200.00Allowable Charge: $175.00Member Responsibility: $0.00 BlueOptionsSlide6
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Taking a look at the Hospitalization Claim – Total Benefit Perspective
BlueEdge
Vs. BlueOptions INPATIENTMember is inpatient and has employee only coverage. Total Charge: $30,000.00Allowable Charge: $20,000.00Deductible: $ 1,500.00 20% after Deductible: $ 2,500.00 BCBSOK Paid: $16,000.00Member Responsibility: $ 4,000.00
BlueEdge
In this scenario, the member is out of pocket less money because the member out of pocket is lower on the BlueOptions Plan for Employee Only Coverage.
Total Charge: $30,000.00Allowable Charge: $20,000.00Deductible: $ 750.0020% after Deductible: $3,500.00 BCBSOK Paid: $16,000.00Member Responsibility: $ 4,250.00 BlueOptions Slide7
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Hospitalization In-Network
OFFICE VISIT Member is inpatient and has Family Coverage. No other member has had any claims process for the current year.
Total Charge: $30,000.00Allowable Charge: $20,000.00Deductible: $ 3,000.00 20% after Deductible: $ 5,000.00 BCBSOK Paid: $12,000.00Member Responsibility: $ 8,000.00 BlueEdge Plan – The provider can bill the member $3,000 at the time of service when they verify benefit coverage during the admissions process. Family deductible is aggregate which means the entire deductible must be met prior to any payment by BCBSOK. BlueOptions –The provider can bill $750.00 at the time of service when they verify benefits coverage during the admission process. Family deductible is embedded, unlike the BlueEdge High Deductible plan, the individual only has to meet their individual deductible and out of pocket maximum amounts.
Total Charge: $30,000.00
Allowable Charge: $20,000.00
Deductible: $ 750.0020% after Deductible: $ 5,000.00 BCBSOK Paid: $15,750.00Member Responsibility: $ 4,250.00 BlueEdge High Deductible BlueOptions Slide8
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Pharmacy Claim
Member fills a brand name prescription at the pharmacy. Total Charge: $175.00Allowable Charge: $125.00Deductible: $125.00Member
Responsibility: $125.00 BlueEdge Plan The member will receive a discount at the time of purchase at the pharmacy. There is no copayment for the BlueEdge plan so the member will be required to pay the entire discounted amount at the time of purchase. The claim is transmitted to BCBSOK to apply to the deductible. When the deductible is satisfied, then the member would only be required to pay 20% at the time of purchase. Total Charge: $175.00Allowable Charge: $125.00Copayment: $50.00 Member Responsibility: $50.00
BlueEdge High Deductible
BlueOptions Slide9
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What are the 2015 premium differences
BENEFITBLUEOPTIONSBLUEEDGE PPO Premium Difference
AnnualizedEmployee Only Coverage$491.40$390.94$100.46$1,205.52Employee and Spouse$1230.50$978.96$251.54$3,018.48Employee and Dependent$890.70
$708.66
$182.04
$2,184.48Family $1618.86$1287.62$331.24$3,974.88Slide10
What is an HSA?
An HSA must be used in combination with a qualified high-deductible health plan (HDHP)
A higher annual deductible
Out-of-pocket maximum applies only to covered expensesNo First dollar coverage (100%) except for preventive care benefits without a deductible
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A
Health Savings Account (HSA)
is a tax-exempt account established exclusively for the purpose of paying qualified medical expenses.Slide11
HSA
ADVANTAGES
FOR EMPLOYERS
Lower
health insurance premiums
Employees make better
health care choices
FOR EMPLOYEESProtects against high / unexpected medical billsMembers decide how much money to put into the account and whether to use it to pay for current qualified medical expenses or save the money for future needs Triple Tax SavingsPortabilityNo “use it or lose it” rules
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Must be enrolled in an HSA-compatible
High Deductible Health Plan (HDHP)
May not have other first dollar medical coverage
If an employee enrolls on the HDHP and uses the HSA option, they could not also be covered under their spouses plan that is NOT HDHP compatible meaning it could not have an office visit copayment, or first dollar coverage under pharmacy. May not be claimed as a dependent on another person's tax returnMay not be enrolled in MedicareAn individual can be Medicare eligible and have an HSA. However, once enrolled in Medicare contributions to the HSA account must stop. The individual can keep any funds in the account prior to enrolling in Medicare and use those funds to pay for qualified medical expenses tax-free.
TO BE ELIGIBLE YOU:
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If made by the individual outside a cafeteria plan,
contributions are a tax-free deduction
If made by the employer, contributions are not taxable to the employee (excluded from income)Contributions can be made by others on behalf of the individual and deducted by the individualIf an individual has more than one HSA, the aggregate annual contributions made to all the HSAs are subject to the limit
HSA
CONTRIBUTION RULESSlide14
U.S. TREASURY GUIDELINES FOR 2015
14Annual Contributions
Self-Only
FamilyHSA Contributions
$3,350
$6,650
Minimum Deductible Amounts
$1,300$2,600Annual Out-of-Pocket (In-network)
$6,450
$12,900“Catch-up” Contributions(Individuals age 55 and older)
$1,000*
Amounts are adjusted annually for inflation.* No change from calendar year 2014Slide15
HSA
account balance
Health Care Transaction
USERS
have multiple options
to
leverage HSA $$$sSAVERSuse personal funds to cover expenses and invest excess
Excess BalanceInvestmentOptions
FLEXIBILITY OF THE BlueEdge HSA
SM15Slide16
BANKING PARTNER
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DIMENSIONS OF INTEGRATION
INTEGRATION FEATURES
Payment Options
Automatic Debit
●
Online bill pay
●
Payment via debit card/checkbook
●
Enrollment & Eligibility
Integrated Enrollment File to Bank●
Web ServicesAccess to balance & transactional details on BAM via real-time web feed
●
Can access bank via single sign-on●
Customer Service Integration
BCBS handles all “tier 1” questions●
Warm transfer to bank for detailed Q’s●CommunicationsBlueEdge Plan communications●Bank custodian communications
●BlueEdge HSASMCustodian Integration Features17Slide18
THE VALUE OF BlueEdge
Banking 2015 Financials*
Account Set Up Fees
$0
Monthly Maintenance Fees – Accountholder Paid
$2.25 waived for balances of $3,000+
Monthly Maintenance Fees – Employer Invoiced/Paid
$2.25 waived for balances of $3,000+
Investment Options
20+ highly rated mutual funds
Balance Threshold prior to investing $1,000
Minimum Investment Amount
Varies by FundInvestment Fees
$2.90 per month
Interest Rate(subject to change at ANY time)Flat, earned on first dollar
Miscellaneous
Other fees may apply* All banks may have additional, miscellaneous fees. Refer to each bank’s fee schedule for additional information.18Slide19
Member Experience
19Slide20
AUTOMATIC HSA DEBIT FOR
MEDICAL (BenefitWallet)
*Assumes PPO network provider. This feature is only available with BenefitWallet.
Member goes to doctor for broken arm
Doctor submits claim to BCBSOK
BCBSOK
processes claim, determines out-of-pocket liability for member (copay, coinsurance, deductible)
AUTO DEBIT ON*
BCBSOK
requests HSA balance informationIf balance available, BCBSOK pays provider directly
BCBSOK creates consolidated EOB with HSA dollars usedIf any remaining patient share, member pays doctor after EOB generated
AUTO DEBIT OFF*
BCBSOK creates EOB that includes patient shareMember receives EOB and pays doctor patient share using bank debit card, bank checkbook, or personal funds20Slide21
AUTOMATIC HSA DEBIT FOR
RX(BenefitWallet/Prime)
*Assumes PPO network provider. This feature is only available with
BenefitWallet and Prime.
Member goes to a pharmacy to fill a prescription
Pharmacy sends claims to PBM
PBM processes
claim and determines the out of pocket liability for member (copay, coinsurance, deductible) at the point of sale
AUTO DEBIT ON*
PBM requests HSA balance informationIf balance available, PBM pulls HSA dollars to pay pharmacy for claim
The pharmacist can see amount due from member (zero if HSA covered RX cost, or partial balance if funds covered only part of Rx cost)
AUTO DEBIT OFF*
Member pays for the RX at the point of sale with bank debit card, bank checkbook, or his/her own personal funds21Slide22
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Other ResourcesSlide25
MyPrime.com and
MyPrimeMail.comLink from Blue Access for Members to:Locate a pharmacyFind drugs / formularyView prescription claim historyCreate personal drug listLearn about specific drugsRx Cost Calculator Health information
PrimeMail Refill a mail order prescriptionCheck the status of an orderStreamlined order refillsManage payment optionsAdd alternative mailing addressSlide26
Advice
anytime.Advice isn’t just needed from 9 to 5. Round-the-clock health and the wellness advice from licensed professionalsMore than 1,200
AudioHealth Library topics
26
Available in English
and
Spanish
800-581-0407
Nurseline
24/7Slide27
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BCBSOK AppFeatures:
Member resourcesFind Doctors or Hospitals near youShop for PlansText BCBSOK APP to 33633 to download**msg and data rates may applyOr
visit store links below:Blue Access MobileSlide28
Monthly Health Topics
Benefits and Claims
Member Wellness Portal
Member Care Profile
Health Assessment
Online Tools
and
Resources
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Cost Estimator tool
Provider
Finder
®
Be Smart. Be Well.
®
eCards for Health
SMHealth Care SchoolBlue Access for MembersSM
ID Card Management
Wellness PointsMember Discounts
Special Beginnings®´Slide29
Some of the 180 videos:
Coronary Artery DiseaseBariatric SurgeryChronic Low Back PainDepressionDiabetesBlood SugarInsulin InjectionsType 2 DiabetesMetabolic Syndrome
Interactive Video Tutorials
Easy to use, technology-powered video coaching modules that enable the most informed treatment decisions Slide30
Expectant mothers and babies
get off to a healthy start with prenatal and
postnatal education and support
Enroll in the program to receive guidance from pregnancy to six weeks after deliveryPregnancy risk assessmentFrequent, personal contact based on riskEducational materialsCoordinated care with your physician
Screening for depression
web
textSlide31
Lifestyle Management
Self-Paced Approach
Online programs
Secure email outreach keeps members on trackPersonalized CoachingWeight Management
& Tobacco Cessation:
Support for a Healthier You
Counseling and coaching with licensed Wellness Coaches24/7 NurselineReferrals when appropriateSlide32
Blue Cross and Blue Shield of
Oklahoma, a Division of Health Care Service Health Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association. © 012 Health Care Service Corporation. All rights reserved.